Category Archives: Health Care

Bacon Bits: Rural Development Edition

Seeding entrepreneurship. The Virginia Coalfield Economic Development Authority has approved $180,000 in seed-capital grants up to $10,000 for businesses that have been operating less than a year and have fewer than 10 full-time employees. The new businesses are projected to create $770,000 in total private investment and create 135 full-time and part-time jobs. Assuming the businesses deliver on their investment and jobs — not to be taken for granted — this looks like a promising approach to economic development. Since it started two years ago, reports the Bristol Herald-Courier, 53 businesses receiving micro-grants have generated $3.1 million in private investment and created 542 full- and -part-time jobs. Beats subsidizing an out-of-state company to build a light manufacturing plant and then shut it down 10 years later.

Addressing the doc shortage. Southwest Virginia has a chronic shortage of doctors, nurses and other health care providers. The United Company Foundation in Bristol is issuing a $1 million challenge grant to the Edward Via College of Osteopathic Medicine in Blacksburg to lower medical school debt for doctors who agree to practice in Southwest Virginia, reports the Roanoke Times. Two $40,000 scholarships will be awarded this spring to third-year medical students. After they complete their residencies, they will be required to work for three years in the region.

To plug the broadband gaps, first you have to find the broadband gaps. Continue reading

Medicaid: Report The Taxes Along With The Growth

Expansion tracking on the Virginia DMAS website. Click to expand, web version is here.

Virginia makes is easy to track the growth of Medicaid enrollment since the decision a year ago to expand coverage but tracking the tax dollars behind the scenes is another matter.

The new enrollment expansion dashboard on the Department of Medical Assistance Services website is updated every couple of weeks, with the April 4 report showing just under 260,000 people added to the program since late last year.  The City of Salem has added the fewest, only 34 new recipients, while Fairfax County has added the most at 18,220.  The advertised goal for expansion was 400,000 persons, so probably there are more to come.  Continue reading

Addiction as a Workforce Development Issue

How ubiquitous is drug abuse in Virginia’s workforce? In western Virginia, it’s mind-numbingly pervasive.

“In many environments, as many as 50 percent of employee applicants who are eligible on the basis of their training, skills, and background fail to be employable because they fail to pass a drug screen,” Dr. Bob Trestman, chairman of psychiatry for Carilion Clinic, told Roanoke-area employers in a panel talk yesterday, reports the Roanoke Times.

Most employers have Employee Assistance Programs but Trestman said employees are reluctant to use them because addicts are stigmatized. “We need to think of them as people with an illness. Then we can reframe how we approach care and treatment and engage and support them in the workplace safely.” Continue reading

Virginia’s “Secret” Medical Marijuana Program

The doctor who should be governor. State Sen. Siobhan Dunnavant is a Republican from Henrico County. She is also a practicing physician. In this year’s General Assembly session she put forth SB1557 which expanded last year’s so-called “Let Doctor’s Decide” legislation (HB1251).

What’s new? The 2018 legislation (HB1251) authorized licensed medical providers to prescribe CBD and THC-A oil “to alleviate the symptoms of any diagnosed condition or disease determined by the practitioner to benefit from such use.” CBD, or cannabidiol, is a naturally occurring compound found in the resinous flower of marijuana plants. It is used to treat a variety of maladies. It is non-intoxicating. THCA, or tetrahydrocannabinolic acid, is the non-psychoactive acid form of THC found in marijuana plants when raw. It is also non-intoxicating unless it is heated. Once heated, THCA releases THC which is intoxicating.  The 2018 legislation restricted THCA oil to contain no more than 5 mg of THC (the psychoactive component of marijuana). Continue reading

Bacon Bits: Economic Research Edition

I periodically check the research papers coming out of the National Bureau of Economic Research (NBER) because they often address issues of interest to Bacon’s Rebellion. The research is far more rigorous from a methodological perspective than the work product of special-interest and advocacy groups, hence more worthy of serious consideration — even when it leads to public-policy implications I don’t like! Here are some quick hits from recent studies:

“The Effects of Rent Control Expansion on Tenants, Landords, and Inequality: Evidence from San Francisco”
“We find rent control increased renters’ probabilities of staying at their addresses by nearly 20%. Landlords treated by rent control reduced rental housing supply by 15%, causing a 5.1% city-wide rent increase.”

Implications: Rent control benefits existing renters but punishes newcomers entering the rental marketplace. Can you say “increasing homelessness?” As zoning codes and other restrictive policies aggravate the supply/demand imbalance here in Virginia, will our politicians avoid the temptation to impose rent controls? Continue reading

Boomergeddon’s Coal Mine Canary Sings Warning

Angry consumer complaints are starting to appear on a growing case record at the State Corporation Commission, which opened the case on its own authority to demand insurance company presentations on the long-term care product market and its history of massive rate hikes.

A typical comment so far: “This frankly, appears to be a ploy of the insurance providers to raise rates so high that they will be completely unaffordable, everyone will drop their policies and the insurers will be able to exit the long term care industry. Consumers must be protected from these predatory practices and these rate hikes must be denied by the SCC.”  Others (the record is here) detail years of steady premium increases and benefit reductions.   Continue reading

Health Care and the Oppression Narrative

County health rankings. Source: Robert Woods Johnson Foundation

Correlation does not equal causality. That’s a fundamental tenet of statistics, but the concept apparently is so rarefied that a Virginia Mercury article based the Robert Wood Johnson Foundation’s County Health Rankings appears to be unfamiliar with it. The result is a headline — “In Virginia, health outcomes follow geographic and racial lines” — that has become standard fare in the ongoing Oppression Narrative embraced by most of Virginia’s media outlets. By misdiagnosing the problem, the Oppression Narrative does a grave dis-service to Virginia’s poor and minorities.

Writes the Virginia Mercury today:

More than 20 percent of Virginia’s black, American Indian and Hispanic populations report poor or fair health, compared to 14 percent of the state’s white residents. …

Year over year, the rankings essentially tell the same story: Virginia’s healthy counties, many of which are nestled in the northern part of the state, remain healthy, while its unhealthy localities, clumped together in the south and southwest, continue to struggle with poor outcomes. …

Continue reading

Squeezing the Most from Every Health Care Dollar

Teaching healthy cooking at Health Brigade’s Food Farmacy.

Medicaid expansion in Virginia is forcing Virginia’s free clinics to make a fundamental choice. Should they participate in Medicaid or not?

Accepting Medicaid payments would provide a new source of funding for clinics, which don’t charge for medical services, and would allow them to continue treating patients who qualify for Medicaid and would otherwise need to seek primary care services elsewhere. But Medicaid generates extensive, complex regulations which must be handled by paid administrative staff.

Health Brigade, formerly known as the Fan Free Clinic, has made the strategic decision not to participate. The clinic, which serves the Richmond area, will forego significant revenue and lose many patients. But there will be no lack of patients to take their place, says Wendy Klein, the clinic’s medical director. While Medicaid expansion will provide insurance coverage to up to 400,000 Virginians, an estimated 300,000 still will have none.

“We take care of people with no insurance and no Medicaid,” says Klein. “There are still a lot of poor people who don’t qualify for Medicaid. Even with expansion, people will fall between the cracks.”

The go/no go decision on Medicaid cuts to the heart of the free clinic business model. It determines the populations they serve, and it shapes their organizational structure. Health Brigade, which is run by socially progressive non-profit entrepreneurs, has concluded that it can accomplish more good as a scrappy, low-overhead outfit filling gaps in the safety net rather than as a cog in the bureaucratic healthcare system. While cultural conservatives may feel uncomfortable with some of Health Brigade’s priorities — it serves transgender patients and illegal immigrants — anyone who believes in a strong civil society will find much to admire in the organization.  Continue reading

Small Steps toward an Innovation-Driven Health System

Tertium Quids, a conservative advocacy organization, has been pushing three bills in the General Assembly designed to bring more “choice and accessibility” to Virginia’s healthcare system.

The goal of the “Virginia Healthcare Basket” Initiative, the group explains, is “to support the growth of innovative business models, insurance options, and technology with an eye toward creating an exciting new healthcare track which runs parallel to the overburdened and cost-prohibitive traditional health and insurance model.”

Conceptually, Democrats don’t have much to offer healthcare than more government involvement and more redistribution of wealth. Virginia Republicans have criticized the march to government-controlled medicine but they have not provided much of an alternative. The proposals touted by Tertium Quids won’t transform Virginia healthcare markets, but they would nudge the state in the direction of more innovative, entrepreneurial, market-driven healthcare. Continue reading

More Medical Insurance Mandates on the Way

Kara Murdoch. Photo credit: The Virginia Mercury

Kara Murdock, 28, lost her right hand and forearm five years ago due to a blood clot, and she has been trying without success to get a prosthetic. Her health plan turned her down when she was covered by her parents’ insurance, and now that she’s on Medicaid under the Medicaid-expansion program, she wants to make sure that her new coverage will include prosthetic devices. So reports The Virginia Mercury in an article about proposed legislation to require all health plans operating in Virginia, including Medicaid, to cover prosthetics.

Murdock’s case is a tragic one — read the story for painful details — and I have no doubt that legislators will be moved by her plight. A bill to mandate prosthetics coverage has been forwarded to the Health Insurance reform Commission, where all new mandates must be studied before the General Asssembly can pass them.

But the argument for a mandate gets complicated. Continue reading

Virginia Hospital Profitability — How Big a Problem?

Community leaders are trying to reopen Lee Memorial Hospital, which closed in 2013.

The number of Virginia hospitals operating at a loss increased dramatically — 43% — between 2016 to 2017, according to the Virginia Hospital and Healthcare Association (VHHA). Overall, one third of Virginia’s acute-care, critical-access, children’s, psychiatric, and rehabilitation hospitals experienced negative operating margins in 2017.

The problem is most acute in Virginia’s rural areas, with 57% of hospitals classified as “rural” operating in the red, said the association in a press release issued yesterday based on data published by Virginia Health Information (VHI). In all 55 of Virginia’s 105 hospitals experienced declines in their operating margins between 2016 and 2017.

The VHHA described Medicaid expansion as “a welcome development that should strengthen the Commonwealth’s health care delivery system.” However, the latest VHI data are “a stark reminder that expansion alone isn’t sufficient to address many of the broader systemic challenges facing Virginia hospitals,” such as Medicare funding cuts, inadequate reimbursements, federal government charity care mandates, and the costs associated with expanding Medicaid.

Everyone should want Virginia to have financially healthy hospitals. It is worrisome if one third of the state’s hospitals are bleeding red. However, the picture is more complicated than presented in the VHHA press release. Maybe the association is making a legitimate point, maybe it’s not. It’s hard to say based on one year’s worth of context-free VHI data. Continue reading

Bacon Bits: Scandal, Scandal, Scandal… and Dental Care

The Old Dominion is looking a lot like the Ante-Bellum Dominion. So, how are Virginia’s political scandals playing out nationally? Not very well. Headline from the New York Post: “Virginia is for Losers.” Lead story in the Wall Street Journal: “Virginia Faces Leadership Crisis as Attorney General Apologizes for Using  Blackface.”

The PC police strike again. But there’s no let-up in the racial identity wars. A fraternity and a sorority at the University of Virginia have been criticized for holding parties in which people dressed up wearing Native American attire in one instance and sombreros and maracas in another, according to the University of Virginia’s Cavalier Daily. The Inter-Fraternity Council issued a statement condemning the attire as “prejudiced and culturally insensitive.” “The IFC condemns these actions and any others that appropriate cultures.” Continue reading

What Principles Govern Virginia’s Approach to Tobacco, Vaping, Marijuana?

What’s she smoking? Is it anybody’s business? In an era in which health care costs are socialized, it’s everybody’s business.

Well, at least General Assembly Republicans are consistent. In the words of the Richmond Times-Dispatch, the House of Delegates “snuffed out” a number of marijuana bills this week, including a proposal backed by Gov. Ralph Northam to decriminalize pot. Meanwhile, they propose tightening the vice on vaping products and raising the legal age for purchasing tobacco from 18 to 21.

Republicans, it appears, are hostile to marijuana, tobacco, and indeed the inhalation of any foreign substance into the lungs. Tobacco, we know, can cause cancer. Vaping amounts to a nicotine delivery system. Nicotine is addictive, but it’s less clear that it represents a national health emergency. Indeed, my 20-year-old son, a vaper, argues that vaping substitutes for smoking tobacco, and that nicotine poses less threat to human health than the toxic brew resulting from combusted tobacco leaf. Continue reading

Shock! More “Surprise” Medicaid Cost Expenditures

Gee, who could have foreseen this? Virginia’s Medicaid expansion will cost more than expected. From the Richmond Times-Dispatch: A hospital tax designed to pay for Medicaid expansion might not cover the expense of administering a key provision of the legislation: a work requirement for people receiving benefits.

The Senate Finance Committee was “taken aback” earlier this week, reports the T-D, to discover that Governor Ralph Northam proposed using $13 million from the General Fund to seek federal approval of a work-requirement waiver. Senate Republican leaders also “expressed surprise” at a new estimate that Medicaid expansion would cost about $85 million more in the upcoming biennium than previously estimated.  Continue reading

Republicans Endorse Autism Bill. In Other Business, They Buy Pig in Poke

Bacon as beast

Republican leaders in the House of Delegates have endorsed a bill to expand coverage for children with autism. Existing law requires health insurers to reimburse autism treatments for children between 2 and 10 years old only. The proposed law would eliminate the cap.

The expanded coverage, which would help an estimated 10,000 people, would cost the state about $237,000 in additional healthcare insurance premiums, according to the Washington Post. Neither the WaPo nor Richmond Times-Dispatch provided an estimate of how much the measure would cost all Virginians, not just state employees. Continue reading